Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain,
Eur J Nucl Med Mol Imaging. 2013 Oct;40(11):1645-55. doi: 10.1007/s00259-013-2476-x. Epub 2013 Aug 2.
Lymphadenectomy in papillary thyroid carcinoma (PTC) continues to be controversial. A better staging method is needed to provide adequate individual surgical treatment. SPECT/CT lymphoscintigraphy and sentinel lymph node (SLN) biopsy may improve lymphatic staging and surgical treatment. Our main objectives were to describe the lymphatic drainage of PTC using lymphoscintigraphy, to evaluate the lymphatic spread (comparing SLN and lymphadenectomy results) and to analyse the impact of SLN identification in surgery.
We prospectively studied 24 consecutive patients with PTC (19 women; mean age 52.7 years, range 22-81 years). The day before surgery, lymphoscintigraphy with ultrasound-guided intratumoral injection ((99m)Tc-nanocolloid, 148 MBq) was performed, obtaining planar and SPECT/CT images. All patients underwent total thyroidectomy, SLN biopsy (hand-held gamma probe) with perioperative analysis, central compartment node dissection, or laterocervical lymphadenectomy if perioperative stage N1b or positive SLNs in this lymphatic basin.
Lymphoscintigraphy revealed at least one SLN in 19 of 24 patients (79 %) on planar and SPECT/CT images, and in 23 of 24 patients (96 %) during surgery using a hand-held gamma probe. Lymph node metastases were detected with classical perioperative techniques (ultrasound guidance and surgical inspection) in 3 of 24 patients, by perioperative SLN analysis in 10 of 23, and by definitive histology in 13 of 24. The false-negative (FN) ratio for SLN was 7.7 % (one patient with bulky lymph nodes). The FN ratio for perioperative frozen sections was 15.4 % (two patients, one with micrometastases, the other with bilateral SLN). Lymphatic drainage was only to the central compartment in 6 of 24 patients (3 of the 6 with positive SLNs for metastases), only to the laterocervical basin in 5 of 24 patients (all unilateral, 2 of 5 positive SLNs) and to the central and laterocervical compartments in 12 of 24 patients (6 of 12 and 3 of 12 positive SLNs, respectively).
Lymphoscintigraphy reveals the lymph node drainage in a high proportion of patients. It detects laterocervical drainage in a significant percentage of patients, allowing the detection of occult lymph node metastases and improving the surgical management in PTC.
甲状腺乳头状癌（PTC）的淋巴结清扫术仍存在争议。需要更好的分期方法来提供适当的个体化手术治疗。SPECT/CT 淋巴闪烁显像和前哨淋巴结（SLN）活检可能改善淋巴分期和手术治疗。我们的主要目的是描述 PTC 的淋巴引流，通过淋巴闪烁显像进行评估，比较 SLN 和淋巴结清扫术的结果，分析 SLN 在手术中的识别对手术的影响。
我们前瞻性研究了 24 例连续 PTC 患者（19 名女性；平均年龄 52.7 岁，范围 22-81 岁）。在手术前一天，使用超声引导下肿瘤内注射（99mTc-纳米胶体，148MBq）进行淋巴闪烁显像，获得平面和 SPECT/CT 图像。所有患者均行全甲状腺切除术，SLN 活检（手持式伽马探针），并进行围手术期分析，中央区淋巴结清扫术，或颈侧区淋巴结清扫术，如果围手术期 N1b 期或该淋巴区域内的 SLN 阳性。
淋巴闪烁显像在 24 例患者中的 19 例（79%）的平面和 SPECT/CT 图像上，以及在 24 例患者中的 23 例（96%）手术中，均显示至少一个 SLN，使用手持式伽马探针。3 例患者通过经典的围手术期技术（超声引导和手术检查），10 例患者通过围手术期 SLN 分析，13 例患者通过明确的组织学检查发现淋巴结转移。SLN 的假阴性（FN）率为 7.7%（1 例患者淋巴结肿大）。冷冻切片的 FN 率为 15.4%（2 例患者，1 例有微转移，另 1 例双侧 SLN）。淋巴引流仅在 6 例患者（6 例中有 3 例 SLN 转移阳性）中仅到中央区，在 24 例患者中的 5 例（均为单侧，5 例中有 2 例 SLN 阳性）中仅到颈侧区，在 24 例患者中的 12 例（6 例和 12 例中有 3 例 SLN 阳性）中到中央和颈侧区。
淋巴闪烁显像显示出患者淋巴结引流的高比例。它检测到颈侧区引流在很大比例的患者中，允许检测隐匿性淋巴结转移，并改善 PTC 的手术管理。
